The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre. / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

Mentally ill patients need to be treated with dignity and their basic human rights must be respected. Community-based interventions are commonly used in many areas after deinstitutionalisation of mentally ill patients. However, it is unfortunate that mental health and mental disorders are neglected in many areas with no proper or standardized services in the community for treatment and support. As a result, most of the mentally ill patients roam in the streets in the rural communities. Exploring community-based interventions in rural areas could assist to improve the quality care of the mentally ill patients. The communities need to be aware of the interventions available to support the mentally ill patients and their family members so that community members who give care to mentally ill patients can be able to identify, implement, monitor and sustain effective interventions to meet the needs of the mentally ill patients in rural areas. Suggestions could also be made to the Department of Health with regard to the community-based interventions in order to improve quality of patient care. The aim of this research was to explore and describe the current community-based interventions for the mentally ill patients as well as explore recommendations by the professional nurses and community caregivers about the utilization of community-based interventions to support mentally ill patients in a rural community. In order to obtain rich in-depth data, a qualitative research approach was followed. A case study design was used to complement the holistic in-depth investigation. Purposive sampling was used to identify professional nurses as participants in the community and snow-ball sampling was used to identify further community caregivers who meet the inclusion criteria. Ethics was considered during the identification and selection of participants. Triangulation of data collection method was undertaken where structured interviews, field notes and documents were used as methods of data collection. A semi-structured interview schedule was formulated which was evaluated by experts in qualitative research. A trial run interview was conducted prior to data collection. Voice recorders were used for the purpose of audio taping the interviews, thereafter the interviews were transcribed and prepared for data analysis. The researcher ensured that field notes were taken immediately after each interview. Data was collected until saturation was reached after ten interviews and analysis of six documents. Data was analysed by means of a written record or transcripts as suggested by Neuwenhuis (2011:89). A specialist qualitative researcher was appointed as a co-coder to analyse the data. The interpretative pattern of data analysis for qualitative data analysis was followed and the guidelines prescribed by Terre Blanche, Durrheim and Kelly (2011:321) were adopted. The identified themes were current interventions and utilizing current suggested interventions. Thus conclusions were drawn in relation to identified themes that with current interventions there are different categories of caregivers that are involved in the care of mentally ill patients in rural communities. Included are the health caregivers, non-governmental organisations, police officers, faith/spiritual healers, traditional healers, families and community members. However challenges were still identified for an example defaulting of treatment, relapse and readmissions of mentally ill patients. With regard to utilizing suggested interventions, participants emphasised more on the need to develop structures in order to support the mentally ill patients in their rural communities and continued community education mental illness and mental health. The recommendations were made to nursing practice, nursing research and nursing education. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Tuberculosis is a health threat, globally, in Africa, South Africa as well as in the North West Province. Although a number of positive interventions have been implemented, like the introduction of direct observation treatment strategy, still tuberculosis remains a threat. This may be due to the fact that while interventions to fight tuberculosis have been formulated and implemented, the most important resource in the Department of Health, which are nurses. Nurses working in the tuberculosis programme who play a vital role in the implementation of the health strategy are left behind and not given the proper support that they need to ensure the implementation of the health strategy. Nurses need to receive physical, emotional and social support from management so that they can give quality care to their patients. The purpose of this study was to explore the support from management to nurses working in the tuberculosis programme in the primary health care facilities at the Matlosana sub-district so as to make recommendations to management with the aim of improving the nurses’ work life and consequently rendering quality care to the tuberculosis patients. The research was conducted in the Matlosana sub-district in the North West Province of South Africa. A qualitative research design was used to explore and describe the support by management to nurses working in the tuberculosis programme in the primary health care facilities. A purposive voluntary sampling method was used to select participants who met the set criteria. In depth Semi structured interviews were conducted. Data was captured on an audio recorder, and transcribed verbatim. The researcher and the co-coder analysed the data after data saturation was reached. A consensus was reached on the categories that emerged. The results showed that most facility managers lack knowledge about tuberculosis making it difficult for them to support nurses working in the tuberculosis programme. The lack of support resulted in the arousal of feelings such as frustration, feeling undermined, feeling unnoticed and unappreciated. It also resulted in resistant behaviours such as underperformance, loss of interest in their work, wanting to leave to where they will be supported and reluctance to take annual leave due to fear of piling work. However, few participants reported supportive experiences from both their facility managers and from the tuberculosis coordinator. Recommendations were made for the field of nursing education, community health nursing practice and nursing research with the aim of improving the nurses’ work life and consequently rendering quality care to the tuberculosis patients. / MCur, North-West University, Potchefstroom Campus, 2013

The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre. / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

Mentally ill patients need to be treated with dignity and their basic human rights must be respected. Community-based interventions are commonly used in many areas after deinstitutionalisation of mentally ill patients. However, it is unfortunate that mental health and mental disorders are neglected in many areas with no proper or standardized services in the community for treatment and support. As a result, most of the mentally ill patients roam in the streets in the rural communities. Exploring community-based interventions in rural areas could assist to improve the quality care of the mentally ill patients. The communities need to be aware of the interventions available to support the mentally ill patients and their family members so that community members who give care to mentally ill patients can be able to identify, implement, monitor and sustain effective interventions to meet the needs of the mentally ill patients in rural areas. Suggestions could also be made to the Department of Health with regard to the community-based interventions in order to improve quality of patient care. The aim of this research was to explore and describe the current community-based interventions for the mentally ill patients as well as explore recommendations by the professional nurses and community caregivers about the utilization of community-based interventions to support mentally ill patients in a rural community. In order to obtain rich in-depth data, a qualitative research approach was followed. A case study design was used to complement the holistic in-depth investigation. Purposive sampling was used to identify professional nurses as participants in the community and snow-ball sampling was used to identify further community caregivers who meet the inclusion criteria. Ethics was considered during the identification and selection of participants. Triangulation of data collection method was undertaken where structured interviews, field notes and documents were used as methods of data collection. A semi-structured interview schedule was formulated which was evaluated by experts in qualitative research. A trial run interview was conducted prior to data collection. Voice recorders were used for the purpose of audio taping the interviews, thereafter the interviews were transcribed and prepared for data analysis. The researcher ensured that field notes were taken immediately after each interview. Data was collected until saturation was reached after ten interviews and analysis of six documents. Data was analysed by means of a written record or transcripts as suggested by Neuwenhuis (2011:89). A specialist qualitative researcher was appointed as a co-coder to analyse the data. The interpretative pattern of data analysis for qualitative data analysis was followed and the guidelines prescribed by Terre Blanche, Durrheim and Kelly (2011:321) were adopted. The identified themes were current interventions and utilizing current suggested interventions. Thus conclusions were drawn in relation to identified themes that with current interventions there are different categories of caregivers that are involved in the care of mentally ill patients in rural communities. Included are the health caregivers, non-governmental organisations, police officers, faith/spiritual healers, traditional healers, families and community members. However challenges were still identified for an example defaulting of treatment, relapse and readmissions of mentally ill patients. With regard to utilizing suggested interventions, participants emphasised more on the need to develop structures in order to support the mentally ill patients in their rural communities and continued community education mental illness and mental health. The recommendations were made to nursing practice, nursing research and nursing education. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Tuberculosis is a health threat, globally, in Africa, South Africa as well as in the North West Province. Although a number of positive interventions have been implemented, like the introduction of direct observation treatment strategy, still tuberculosis remains a threat. This may be due to the fact that while interventions to fight tuberculosis have been formulated and implemented, the most important resource in the Department of Health, which are nurses. Nurses working in the tuberculosis programme who play a vital role in the implementation of the health strategy are left behind and not given the proper support that they need to ensure the implementation of the health strategy. Nurses need to receive physical, emotional and social support from management so that they can give quality care to their patients. The purpose of this study was to explore the support from management to nurses working in the tuberculosis programme in the primary health care facilities at the Matlosana sub-district so as to make recommendations to management with the aim of improving the nurses’ work life and consequently rendering quality care to the tuberculosis patients. The research was conducted in the Matlosana sub-district in the North West Province of South Africa. A qualitative research design was used to explore and describe the support by management to nurses working in the tuberculosis programme in the primary health care facilities. A purposive voluntary sampling method was used to select participants who met the set criteria. In depth Semi structured interviews were conducted. Data was captured on an audio recorder, and transcribed verbatim. The researcher and the co-coder analysed the data after data saturation was reached. A consensus was reached on the categories that emerged. The results showed that most facility managers lack knowledge about tuberculosis making it difficult for them to support nurses working in the tuberculosis programme. The lack of support resulted in the arousal of feelings such as frustration, feeling undermined, feeling unnoticed and unappreciated. It also resulted in resistant behaviours such as underperformance, loss of interest in their work, wanting to leave to where they will be supported and reluctance to take annual leave due to fear of piling work. However, few participants reported supportive experiences from both their facility managers and from the tuberculosis coordinator. Recommendations were made for the field of nursing education, community health nursing practice and nursing research with the aim of improving the nurses’ work life and consequently rendering quality care to the tuberculosis patients. / MCur, North-West University, Potchefstroom Campus, 2013

SAMMANFATTNING   Verksamhetsförlagd utbildning (VFU) har stor betydelse för studenternas lärande och kräver samordning mellan universitet och vårdenheter. Förklaringsgrunder och problematisering av praktiskt lärande är inte lika vanligt förekommande som att studera teoretisk förståelse . Det finns behov av pedagogisk utveckling av VFU. Syfte: Syftet med denna studie var att studera sjuksköterskestudenters uppfattning om måluppfyllelse gällande hälsofrämjande arbete, vid VFU i primärvården. Metod: En deskriptiv, kvalitativ design användes med fenomenografisk ansats. Tio sjuksköterskestudenter intervjuades. Resultat: Den fenomenografiska analysen resulterade i sju kvalitativt skilda beskrivningskategorier hierarkiskt ordnade underifrån;  universitetets betydelse och handledarens betydelse därefter komplex roll som student, otydligt mål för hälsofrämjande arbete och reflektion underlättade att förstå hälsofrämjande arbete. Två beskrivningskategorier låg högst upp bristande förutsättningar för aktivt deltagande och passivt deltagande gav helhet över exempel på hälsofrämjande arbete. Slutsats: Kunskap om sjuksköterskestudenters uppfattningar, i synnerhet gällande bristande förutsättningar för aktivt deltagande i hälsofrämjande arbete samt att passivt deltagande gav helhet över att kunna ge exempel på hälsofrämjande arbete, kan vägleda universitet och yrkeshandledare i utveckling av handledning vid VFU i primärvården. / ABSTRACT   Clinical education is important for student learning and requires coordination between universities and healthcare clinics. Fundamental explanations of clinical education are not as common as the study of theoretical understanding. There is a need for pedagogical development of clinical education. Aim: The aim of this study was to explore nursing students' perception of fulfillment of objective outcomes regarding health promotion, during clinical education in primary care. Method: A descriptive, qualitative design was used with phenomenographic approach. Ten nursing students were interviewed. Results: The phenomenographic analysis resulted in seven qualitatively different categories of description hierarchically ordered from below; importance of university and importance of the nursing supervisor then complex role as a student, unclear objectives for health promotion and reflection facilitated the understanding of health promotion. Two categories of description were on the top of the hierarchy lack of opportunities for active participation and passive participation gave wholeness of examples of health promotion. Conclusion: Knowledge of nursing students' perceptions, especially regarding lack of opportunities for active participation in health promotion and that passive participation gave wholeness of examples of  health promotion, can guide universities and nursing supervisors in their development of clinical education in primary care.

Bakgrund: Välbefinnande berör alla yrkeskategorier, inte minst hälso- och sjukvårdspersonal. Det är viktigt att uppleva välbefinnande för att kunna utföra god omvårdnad. Ett nytt mätinstrument kallat Job-Related Social Well-Being Scale (JSWS) har utvecklats av Ali Kazemi och har testats bland personal inom skolan och industrin men inte inom hälso- och sjukvård. Syfte: Syftet med denna studie var att bland hälso- och sjukvårdspersonal undersöka applicerbarheten hos ett mätinstrument avsett att mäta socialt välbefinnande på arbetet. Metod: Denna pilotstudie hade en kvantitativ ansats. Datainsamlingen med JSWS och KASAM gjordes genom webbaserade enkäter som distribuerades till hälso- och sjukvårdspersonal inom primärvården vid två tillfällen. Antal möjliga respondenter var 188, vid första mättillfället besvarade 27 respondenter enkäten och vid andra mättillfället 11 respondenter. Spearmans rangkorrelation användes för att studera applicerbarheten. Som jämförelseinstrument användes den korta versionen av KASAM-formuläret. Resultat: Test-retest var signifikant (rs=0.90; p<0.01). Stabilitet över mätinstrument samt kriterievaliditet visade på en ickesignifikant korrelation (rs=0.327; p<0.1) mellan JSWS och KASAM. Konklusion: Denna pilotstudie visade att metoden bör förbättras för att få högre svarsfrekvens så att generaliseringar kan göras. Stabilitet över mätinstrument och kriterievaliditet indikerar att i en huvudstudie med fler respondenter skulle resultatet hamna på en signifikant nivå. / Background: Wellbeing at work concerns all professionals, including healthcare professionals. It is important to experience wellbeing for being able to take care of patients. A new instrument, Job-Related Social Well-Being Scale (JSWS), developed by Ali Kazemi has been tested among professionals in school and industry, not among healthcare professionals. Aim: The aim of this pilot study was among healthcare professionals study the applicability of an instrument intended to measure social wellbeing at work. Method: This pilot study had a quantitative approach. The datacollection with JSWS and the short version of Sense of Coherence (SOC-13)  was done through webbased survey distributed to professionals in primary healthcare at two occasions, to 188 possible respondents. The number of respondents in the first measurement were 27 and in the second 11. Spearmans rankcorrelation (rs) was used to study the applicability. SOC-13 was used as the comparison instrument. Results: The test-retest is significant (rs=0.90; p<0.01). The equivalence and criterion validity shows a non significant correlation (rs=0.327; p<0.1) between JSWS and SOC-13. Conclusion: This pilot study showed that the method should be improved to recieve more respondents so generalizations can be done. Equivalence and criterion validity indicates that in a main study with more respondents, the results would be at a significant level.

Många äldre personer med kronisk sjukdom vårdas i det egna hemmet och behöver ofta insatser från öppenvården. Syftet var att belysa upplevelser av kommunikation för den äldre personen med kronisk sjukdom i mötet med öppenvården. Studien genomfördes som en litteraturstudie med 10 vetenskapliga artiklar. Betydelsen av att få tid och av att vårdpersonal lyssnar aktivt framstod som viktigt. Vidare vill de äldre personerna med kronisk sjukdom känna medkänsla genom att få uppmärksamhet och vänligt bemötande. Ökad tillit upplevs när kommunikationen har god kvalitet. Delaktighet i omvårdnaden skapar möjlighet att följa de råd som ges och förutsättningar att leva med och hantera sin kroniska sjukdom och åldrandet bättre. Utbildning för sjuksköterskestudenter och verksamma sjuksköterskor i öppenvård samt forskning inom kommunikation är betydelsefullt i framtiden. Detta kan skapa förutsättningar till en förtroendeingivande och trygg tillvaro för den äldre personen med kronisk sjukdom. / Many older people with chronic illness are cared for in their own homes and often need input from outpatient care. The aim was to highlight the experiences of communication for the older person with chronic illness in the meeting with outpatient care. The study was conducted as a literature review of 10 scientific papers. The importance of having time for conversation and that health professional listens actively emerged. The older persons with chronic disease want to feel compassion by getting attention and friendly treatment. Reliance occurs when communication has good quality. Participation in the care creates the opportunity to follow the advice given and the ability to live with and manage their chronic disease and the aging process better. Education for nursing students and nurses working in out patient care and research in communication is important in the future. This can create conditions for a credible and safe environment for the older person with chronic illness.

Darbo tikslas. Įvertinti Šiaulių centro poliklinikos teikiamų pirminės sveikatos priežiūros paslaugų kokybę pacientų bei gydytojų požiūriu. Uždaviniai. 1. Atskleisti sveikatos priežiūros paslaugų kokybės sampratą ir esmę, teorines vertinimo prieigas. 2. Parengti teorinį pirminės sveikatos priežiūros paslaugų kokybės vertinimo modelį. 3. Įvertinti Šiaulių centro poliklinikos teikiamų paslaugų kokybę pacientų požiūriu. 4. Išanalizuoti gydytojų nuomonę apie pirminės sveikatos priežiūros paslaugų kokybę. Tyrimo metodika. Sveikatos priežiūros paslaugų kokybės įvertinimui taikytas anketinės apklausos metodas. Empiriniame tyrime dalyvavo 33 Šiaulių centro poliklinikos gydytojai ir 296 pacientai. Rezultatai. Atlikto Šiaulių centro poliklinikos teikiamų paslaugų kokybės tyrimo pacientų požiūriu rezultatai parodė, kad pirminės sveikatos priežiūros paslaugų kokybė labai gerai įvertinta pacientų lūkesčių, įstaigos veiklos bei gydytojų konsultacijų aspektais. Aukštą kokybę gydytojų etinės elgsenos aspektu riboja dalies gydytojų nenoras diskutuoti apie pacientų nepasitenkinimą paskirtu gydymu. Šiaulių centro poliklinikos teikiamų paslaugų kokybės įvertinimas gydytojų požiūriu parodė, gydytojai finansinėmis pajamomis už papildomas veiklas yra motyvuojami teikti kokybiškas sveikatos priežiūros paslaugas. Aukštą sveikatos priežiūros paslaugų kokybę gydytojai stengiasi užtikrinti per nenutrūkstamą paslaugų teikimą: sudarant galimybę pacientams kreiptis į šeimos ar budintį gydytoją bet kuriuo... [toliau žr. visą tekstą] / Aim of the study. To evaluate quality of primary health care services in Siauliu centro poliklinika from patients’ and doctors’ point of view. Objectives. 1. To reveal concept and essence of health care quality, theoretical approaches to its evaluation. 2. To prepare theoretical model for evaluation of primary health care quality. 3. To evaluate quality of primary health care services in Siauliu centro poliklinika from patients’ point of view. 4. To analyse doctors’ attitudes to quality of primary health care services. Methods. A questionnaire survey was applied for the evaluation of quality of health care services. 33 doctors of Siauliu centro poliklinika and 296 patients took part in empirical survey. Results. The accomplished survey of quality of health care services in Siauliu centro poliklinika from customers point of view presented that quality of primary health care services was evaluated as high through expectations of patients, activity of institution and doctors’ consultations. Quality of services is limited due to doctors’ avoidance to discuss patients’ lack of satisfaction with given treatment. Evaluation of quality of health care services in Siauliu centro poliklinika from doctors’ point of view indicate that doctors are motivated to render high quality services through income received due to complementary activity. Doctors seek to make high quality services certain through continuous provision of services as patients can apply to family doctor at any time of... [to full text]